Provider Demographics
NPI:1407556608
Name:ELLISON MANAGEMENT PLLC
Entity Type:Organization
Organization Name:ELLISON MANAGEMENT PLLC
Other - Org Name:ELLISON FAMILY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LEVI
Authorized Official - Middle Name:
Authorized Official - Last Name:ELLISON
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:501-701-0587
Mailing Address - Street 1:2503 AVERITT AVE
Mailing Address - Street 2:
Mailing Address - City:MENA
Mailing Address - State:AR
Mailing Address - Zip Code:71953-3489
Mailing Address - Country:US
Mailing Address - Phone:501-701-0587
Mailing Address - Fax:
Practice Address - Street 1:601 HIGHWAY 71 N
Practice Address - Street 2:
Practice Address - City:MENA
Practice Address - State:AR
Practice Address - Zip Code:71953-4394
Practice Address - Country:US
Practice Address - Phone:479-385-9400
Practice Address - Fax:479-385-2731
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-06
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy